Provider Demographics
NPI:1811354004
Name:SPROUL, JODY M (FNP-BC)
Entity type:Individual
Prefix:MS
First Name:JODY
Middle Name:M
Last Name:SPROUL
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1180 RESURGENCE DR
Mailing Address - Street 2:STE 100
Mailing Address - City:WATKINSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30677-7211
Mailing Address - Country:US
Mailing Address - Phone:706-543-5858
Mailing Address - Fax:
Practice Address - Street 1:3350 BERKMAR DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22901-1491
Practice Address - Country:US
Practice Address - Phone:434-923-4651
Practice Address - Fax:349-643-6364
Is Sole Proprietor?:No
Enumeration Date:2016-01-20
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GARN304309363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0024175956OtherSTATE LICENSE
VA0024175956OtherSTATE LICENSE